To MEAT Or Not To MEAT?
I recently got back from an ACDIS chapter conference and managed to engage in an interesting conversation with one of the speakers. During the presentation, the speaker mentioned “No MEAT, please!” when presenting to the attendees.
If I understood correctly, the speaker was basing this on the fact that there is no official guideline to using MEAT when documenting for HCC-relevant diagnoses, or really any other viable diagnoses for a patient’s stay. Of course, I disagreed, and below are my reasons for doing so.
What Is MEAT?
It is well understood in the industry that the acronym MEAT is widely used to suggest that if a diagnosis is Monitored, Evaluated, Assessed, or Treated, then the diagnosis should be documented. Conversely, it could also mean that if you are documenting a diagnosis, then your thought process or documentation regarding monitoring, assessing, evaluating, or treating a condition should also be included.
I must stress that this is only a personal guideline, at which point I will agree with the speaker that there is no “official” source for it, but as a personal guideline, it has offered me tremendous value. However, when you are appealing a denial, using this acronym alone will not be acceptable, but then again, if you are appealing denials based on acronyms, then you must revamp your appeals process.
The Problem With “No MEAT, Please!”
If you have followed my previous blog posts, you will know that I believe that the industry is skewed. I believe that we have spent far too many resources and energy on making the act of generating queries more efficient versus trying to change the documentation practices of physicians. There is room for a balance between the two, but right now, for an industry that has been around for more than a decade, it appears as though we have not done a very good job of changing basic physician documentation practices.
This is one of the reasons that the same queries keep going to the same physicians on the same diagnoses month in and month out. Most physicians will never become subject-matter experts in CDI, but that’s what our CDSs are there for. I do, however, believe that the core fundamentals of CDI should, at least by now, be practiced by all clinicians.
MEAT, if used as a general guideline for physicians, is a very valuable resource to help them provide what is needed for a diagnosis to be compliantly captured. The physician at the bedside needs the shortest distance between two points if CDI is to take up space on their priority list. MEAT helps them get there, and if it enables a physician to give you more information surrounding the diagnosis than what they have historically been doing, then use it!
Getting more information from a physician on diagnoses that they are monitoring, evaluating, treating, or assessing does not need an “official guideline”. Let me reiterate, though: The “official guideline” will become necessary if you are going to use it to write an appeal, which, as mentioned, should not be the case anyway.
A universal statement of “No MEAT, please!” could be interpreted by many CDSs across the country, who have daily opportunities to provide education to physicians, to stay away from it all together, preventing them from articulating to providers just what is required from them.
If you want to keep all the official guidelines to yourself and continue to exist in a world where physicians use the CDI program as a crutch rather than a safety net, then yes, go ahead and keep vital information away from them. But if you intend to make a difference in the long-term documentation behavior of physicians, then give them any tool you can, whether it is an acronym, education, technology, or data, to ensure that your efforts result in lasting changes.
As an educator, I have frequently used acronyms with physicians, and it works, especially if it is catchy. Here’s one that I have asked physicians to adopt:
P: Principle Diagnosis (not symptoms)
C: Chronic Conditions and Comorbidities
S: Specificity and severity
Asking a physician to put their daily documentation (including the discharge summary) through its “PACES” has worked for me and has worked for others. It allows me to systematically go through, in my mind, the patient’s diagnoses and what is required when documenting their conditions. No official guideline is needed for me to give you more information.
“The key test for an acronym is to ask whether it helps or hurts communication.”